"Million Hearts" initiative aims to reduce cardiovascular disease burden

The Dept. of Health and Human Services in September launched an ambitious plan to prevent 1 million heart attacks and strokes in the next five years.

More than 2 million Americans have a heart attack or stroke annually, and 800,000 of them die, according to the American Heart Assn., one of the many organizations taking part in the initiative. If the plan succeeds, an additional 30 million Americans will have their high cholesterol or hypertension under control and 4 million will quit smoking by 2017.

The wide-ranging, $200 million project, dubbed the "Million Hearts" initiative, focuses on what it calls the "ABCs" of preventing cardiovascular disease:

• Aspirin for high-risk patients.
• Blood pressure control.
• Cholesterol management.
• Smoking cessation.

While the Patient Protection and Affordable Care Act can help expand insurance coverage so patients can get care when they need it, the new initiative aims to cut down on the kinds of expensive care they will require, said Donald M. Berwick, MD, administrator of the Centers for Medicare & Medicaid Services.

"The treatment of heart disease and stroke accounts for about $1 of every $6 spent on health care in this country," Dr. Berwick said. "By shifting our focus from paying for how much care is provided to how to get the best health for Americans and putting more tools into the hands of health care providers and patients, CMS can help prevent strokes, heart attacks and avoidable human suffering."

CMS plans to incorporate performance metrics related to heart disease prevention into the Physician Quality Reporting System as well as electronic medical record meaningful use criteria. Starting in 2012, the Health Resources and Services Administration will require all community health centers to report annually on cardiovascular disease prevention measures. Health information technology grants will help nearly 100,000 primary care physicians track and improve their performance on these metrics, government officials said.

Other parts of the initiative will directly target patient behavior. In September 2012, the Food and Drug Administration will require prominent health warnings on all cigarette packs to deter smoking. New menu-labeling requirements are aimed at helping patients make healthier choices in chain restaurants. The FDA and the Centers for Disease Control and Prevention will work with food makers to reduce the amount of sodium and trans fats in their products.

"The AMA recognizes that the major contributors to cardiovascular disease are tobacco use, diet and lack of physical activity, and has developed tools and resources like the AMA Healthier Life Steps program to help physicians counsel patients on these key behaviors," said Robert M. Wah, MD, chair of the AMA Board of Trustees. "To help physicians improve the quality of patient care, the AMA's Physician Consortium for Performance Improvement developed preventive care and screening measures on obesity as well as tobacco use and cessation."

Consortium metrics on blood pressure assessment, adult weight screening, tobacco use and cessation, and lowering cholesterol with medication already are part of the core set of measures for EMR meaningful use. HHS did not respond to an inquiry by this article's deadline regarding what, if any, additional quality metrics will be added to help further the goals of the initiative.

The American College of Cardiology, which helped propose the initiative, said new point-of-care tools and data registries will help physicians deliver the right treatments and track patient outcomes. Janet Wright, MD, the college's senior vice president for science and quality, is directing the Million Hearts campaign.

"Million Hearts will make huge strides in educating the public about these important health issues," said Jack Lewin, MD, CEO of the American College of Cardiology.

Education at the pharmacy

The government plan secured promises from Walgreens and several pharmacy-related trade groups to increase the amount of blood pressure testing and counseling they do. The CDC also announced $2 million in grants for such pharmacy outreach.

"I spent 20 years as a drug shop owner, and we did blood pressure screenings every month, and we often referred people whose readings were out of whack," said Thomas Menighan, CEO of the American Pharmacists Assn. "That's part of every pharmacy's practice in the U.S. What this initiative is doing is taking that routine and punching it up a little bit and giving it more visibility."

As part of the campaign, pharmacists will provide educational materials to patients and talk with them about the consequences of undiagnosed hypertension. Cardiovascular disease is responsible for one-third of U.S. deaths each year, the CDC says.

"The federal government is taking aim at a continuing problem," Menighan said. "When you look at all the statistics on incidence of heart disease and the lack of awareness -- that continues despite previous efforts. HHS is saying we need to put a spotlight on this and pull people together and saying this is a public health problem for all of us."